Skip to main content
SpringerLink
Log in

Risk factors associated with severity, prognosis, and evolution of patients with tropical diabetic hand syndrome

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Objective

Tropical diabetic hand syndrome (TDHS) is rarely described and recognized in the literature as a complication in people with diabetes, and Mexico has high incidence rates of diabetes mellitus II (DMII). The minor or major amputation of the arm represents a physically and economically significant morbidity problem in patients. To optimize the diagnosis and treatment, in this work, we identify prognostic factors and their association with the severity of TDHS and the need for amputation in patients with diabetes mellitus and hand tissue infection.

Methods

A total of 55 patients with a confirmed diagnosis of DMII with soft tissue infection in the hand referred to the plastic and reconstructive surgery department were studied for their evaluation and treatment. We analyze sociodemographic and clinical factors and follow-up of remission and recovery in limb functions.

Results

In our study, we identified factors associated with amputation such as schooling under 6 years (OR: 21.98, confidence interval (CI): 1.21–3.98, p = 0.003), body mass index ≥ 20 (OR: 0.07, CI = 0.003–1.41, p = 0.031), and history of amputation (no upper limb) (OR: 5.9, CI = 1.11–32.1, p = 0.032). Furthermore, people with TDHS requiring amputation had slightly higher glycated hemoglobin (Hb1Ac) ≥ 10% (OR: 2.36, CI = 0.62–8.98, p = 0.338), and the risk of death was also increased (OR: 3.4, CI = 0.355–32.6, p = 0.288), although these outcomes did not reach statistical significance.

Conclusions

Risk factors for amputation as a treatment of THDS are directly linked to lower schooling status, poor nutrition/low weight, as well as previous amputation procedures in patients. These data will help to establish a timelier evaluation and management in patients with suspected THDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Data collected during this study are available through direct contact with the corresponding author.

References

  1. Gill GV, Famuyiwa OO. Tropical diabetic hand syndrome. Lancet. 1998;351:113–4.

    Article  CAS  PubMed  Google Scholar 

  2. Jalil A, Barlaan PI, Fung BKK, Ip JWY. Hand infection in diabetic patients. Hand Surg. 2011;16:307–12. https://doi.org/10.1142/S021881041100559X.

    Article  PubMed  Google Scholar 

  3. Ezeani I, Edo A. Case series on tropical diabetic hand syndrome. Niger J Clin Pract. 2014;17:540–2.

    Article  CAS  PubMed  Google Scholar 

  4. Boulton AJM, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28:956–62. https://doi.org/10.2337/diacare.28.4.956.

    Article  PubMed  Google Scholar 

  5. Lawal Y, Ogirima M, Dahiru I, et al. Tropical diabetic hand syndrome: surgical management and proposed classification. Arch Int Surg. 2013;3:124–7. https://doi.org/10.4103/2278-9596.122931.

    Article  Google Scholar 

  6. Wang C, Lv L, Wen X, et al. A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centre. Diabet Med. 2010;27:848–51. https://doi.org/10.1111/j.1464-5491.2010.03012.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gill GV, Famuyiwa OO, Rolfe M, Archibald LK. Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts. Diabet Med. 1998;15:858–62. https://doi.org/10.1002/(SICI)1096-9136(199810)15:10%3c858::AID-DIA698%3e3.0.CO;2-Z.

    Article  CAS  PubMed  Google Scholar 

  8. Chatterjee N, Chattopadhyay C, Sengupta N, et al. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India. Indian J Endocrinol Metab. 2014;18:217–20. https://doi.org/10.4103/2230-8210.129115.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chong CW, Ormston VE, Tan ABH. Epidemiology of hand infection–a comparative study between year 2000 and 2009. Hand Surg. 2013;18:307–12. https://doi.org/10.1142/S0218810413500317.

    Article  PubMed  Google Scholar 

  10. Ngim NE, Amah P, Abang I. Tropical diabetic hand syndrome: report of 2 cases. PanAfrican Med J. 2001;47:788–9.

    Google Scholar 

  11. Abbas ZG, Archibald LK. Tropical diabetic hand syndrome: epidemiologý, pathogenesis and management. Am J Clin Dermatol. 2005;6:21–8.

    Article  PubMed  Google Scholar 

  12. Abbas ZG, Lutale J, Gill GV, Archibald LK. Tropical diabetic hand syndrome: risk factors in an adult diabetes population. Int J Infect Dis. 2001;5:19–23. https://doi.org/10.1016/S1201-9712(01)90043-8.

    Article  CAS  PubMed  Google Scholar 

  13. Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. Int J Infect Dis. 2006;10:315–9. https://doi.org/10.1016/j.ijid.2005.06.009.

    Article  PubMed  Google Scholar 

  14. Tosti R, Ilyas AM. Empiric antibiotics for acute infections of the hand. J Hand Surg Am. 2010;35:125–8. https://doi.org/10.1016/j.jhsa.2009.10.024.

    Article  PubMed  Google Scholar 

  15. Yeika EV, Tchoumi Tantchou JC, Foryoung JB, et al. Tropical diabetic hand syndrome: a case report. BMC Res Notes. 2017;10:17–20. https://doi.org/10.1186/s13104-017-2405-3.

    Article  Google Scholar 

  16. Nthumba P, Cavadas PC, Landin L. The tropical diabetic hand syndrome: a surgical perspective. Ann Plast Surg. 2013;70:42–6. https://doi.org/10.1097/SAP.0b013e3182305e96.

    Article  CAS  PubMed  Google Scholar 

  17. Liu Y, Liu Y, Wang P, et al. Autologous bone marrow stem cell transplantation for the treatment of postoperative hand infection with a skin defect in diabetes mellitus: a case report. Oncol Lett. 2014;7:1857–62. https://doi.org/10.3892/ol.2014.1998.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Papanas N, Maltezos E. The diabetic hand: a forgotten complication? J Diabetes Complications. 2010;24:154–62. https://doi.org/10.1016/j.jdiacomp.2008.12.009.

    Article  PubMed  Google Scholar 

  19. Ince B, Dadaci M, Arslan A, et al. Factors determining poor pronostic outcomes following diabetic hand infections. Pak J Med Sci. 2015;31:532–7.

    PubMed  PubMed Central  Google Scholar 

  20. Akintewe TA, Odusan O, Akanji O. The diabetic hand–5 illustrative case reports. Br J Clin Pract. 1984;38:368–71.

    Article  CAS  PubMed  Google Scholar 

  21. OECD. Health at a Glance 2017: OECD Indicators. Paris: OECD Publishing; 2017. https://doi.org/10.1787/health_glance-2017-en.

  22. Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil1. 1985;66:69–72. https://doi.org/10.1177/1758998313479874.

    Article  CAS  Google Scholar 

  23. Mallon WJ, Brown HR, Nunley JA. Digital ranges of motion: normal values in young adults. J Hand Surg Am. 1991;16:882–7. https://doi.org/10.1016/S0363-5023(10)80155-8.

    Article  CAS  PubMed  Google Scholar 

  24. Aydin F, Kaya A, Savran A, et al. Diabetic hand infections and hyperbaric oxygen therapy. Acta Orthop Traumatol Turc. 2014;48:649–54. https://doi.org/10.3944/AOTT.2014.3225.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all the staff of the emergency unit and the nursing staff of the "Dr. José Eleuterio González" University Hospital for the commitment and care provided to the study participants.

Author information

Authors and Affiliations

  1. Servicio de Cirugía Plástica, Estética y Reconstructiva, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero y Av. Gonzalitos S/N., Monterrey, Nuevo León, C.P. 64460, México

    Arnulfo A. Ríos-Cantú, Jorge A. Garza-Cerna, Hernán Chacón-Moreno, Yanko Castro-Govea, Everardo Valdés-Flores & Mauricio M. García-Pérez

Authors
  1. Arnulfo A. Ríos-Cantú
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jorge A. Garza-Cerna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hernán Chacón-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanko Castro-Govea
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Everardo Valdés-Flores
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauricio M. García-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yanko Castro-Govea.

Ethics declarations

Ethics approval and consent to participate

The authors certify that this work complies with international standards for research practice and reporting. This study protocol was reviewed and approved by the ethics committee of our institution (Comité de ética e investigación del Hospital Universitario “Dr. José Eleuterio González”–Universidad Autónoma de Nuevo León) and the decision reference number is CP16–00001. All informed consent collected during this study was obtained, concisely, legally, and without coercion of any kind.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ríos-Cantú, A.A., Garza-Cerna, J.A., Chacón-Moreno, H. et al. Risk factors associated with severity, prognosis, and evolution of patients with tropical diabetic hand syndrome. Int J Diabetes Dev Ctries (2023). https://doi.org/10.1007/s13410-023-01267-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13410-023-01267-4

Keywords

Search

Navigation